Knowledge, perception, and willingness of digital psychiatry among psychiatrists in Pakistan: a multicenter cross-sectional study

Abstract

Aim: A comprehensive understanding of current digital literacy and perspectives of the psychiatric workforce is important to introduce appropriate digital psychiatry interventions and implement contextually relevant measures in Pakistan. This study aims to address a gap in the existing literature by assessing psychiatrists’ knowledge, attitudes, perceived barriers, and willingness to integrate digital psychiatry into their clinical practice.

Methods: A cross-sectional online survey was conducted from January 2023 to June 2023 across psychiatric departments of 18 public hospitals in Pakistan. The study included psychiatry residents, fellows, and consultants. A 48-item questionnaire, internally and externally validated, assessed knowledge, perceptions, and willingness to adopt digital psychiatry tools-telepsychiatry, artificial intelligence, mental health applications, and virtual reality. Data were analyzed using Statistical Package for the Social Sciences (version 26) for descriptive statistics, correlation, and regression analyses, while thematic analysis of open-ended responses was performed using Quirkos.

Results: A total of 200 participants (56.0% aged 20–30 years, n = 112; 55.5% male, n = 111) were part of this study. 68.5% (n = 137) understood the applications of telepsychiatry, while 72.5% (n = 145) agreed that it is time-efficient and cost-effective. Only 39.5% (n = 79) of participants had received relevant artificial intelligence training to incorporate it in their psychiatric clinical practice. 62.0% (n = 124) of respondents reported unfamiliarity with the use of mental health applications. Regarding virtual reality, 32.5% (n = 65) were familiar with the technology, but only 42.5% (n = 85) were aware of its applications in psychiatric care. Thematic reflexive analysis revealed major challenges, including a ‘lack of infrastructure/resources’ (44.5%, n = 89) and a ‘lack of education/awareness’ (21.5%, n = 43).

Conclusions: This study represents the first cross-sectional examination of digital psychiatric literacy in Pakistan’s healthcare system, which revealed significant gaps in digital health competencies among psychiatrists. Given the vast potential of emerging technologies in addressing mental health challenges, there is an urgent need for mental health professionals in Pakistan to integrate digitization in psychiatric practice.

Keywords

telepsychiatry / artificial intelligence / mental health apps / virtual reality / digital psychiatry / Pakistan

References

[1] World Health Organization. World mental health report: transforming mental health for all. Geneva: WHO; 2022.

[2] World Health Organization. Mental Health ATLAS 2020. Geneva: WHO; 2021.

[3] COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide [Internet]. Geneva: WHO; c2025 [cited 2024 Feb 11]. Available from:https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide

[4] Patel V, Saxena S, Lund C, Thornicroft G, Baingana F, Bolton P, et al. The Lancet Commission on global mental health and sustainable development. Lancet. 2018; 392:1553-98.

[5] Shore JH, Yellowlees P, Caudill R, Johnston B, Turvey C, Mishkind M, et al. Best Practices in Videoconferencing-Based Telemental Health April 2018. Telemed J E Health. 2018; 24:827-32.

[6] Vidyasagaran AL, McDaid D, Faisal MR, Nasir M, Muliyala KP, Thekkumkara S, et al. Prevalence of mental disorders in South Asia: A systematic review of reviews. Glob Ment Health (Camb). 2023; 10:e78.

[7] Garg K, Kumar CN, Chandra PS. Number of psychiatrists in India: Baby steps forward, but a long way to go. Indian J Psychiatry. 2019; 61:104-5.

[8] Basavarajappa C, Grover S, Dalal PK, Avasthi A, Kumar CN, Manjunatha N, et al. Current telepsychiatry practice in India - An online survey of psychiatrists. Indian J Psychiatry. 2022; 64:307-11.

[9] Um-e-Kalsoom, Bibi N. Consequences of COVID-19 pandemics on the mental well-being of general population of Pakistan. Middle East Curr Psychiatry. 2022; 29:44.

[10] World Health Organization. Mental health atlas country profiles 2020: Pakistan. Geneva: WHO; 2020.

[11] Akhtar S, Rabbani F, Nafis J, Siddiqui A, Merali Z. A qualitative study assessing acceptability and appropriateness of a technology-assisted mental health intervention by community frontline workers: mPareshan implementation research in rural Pakistan. BMC Psychiatry. 2025; 25:16.

[12] Orsolini L, Jatchavala C, Noor IM, Ransing R, Satake Y, Shoib S, et al. Training and education in digital psychiatry: A perspective from Asia-Pacific region. Asia Pac Psychiatry. 2021; 13:e12501.

[13] Torous J, Bucci S, Bell IH, Kessing LV, Faurholt-Jepsen M, Whelan P, et al. The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality. World Psychiatry. 2021; 20:318-35.

[14] COVID-19 Mental Disorders Collaborators. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet. 2021; 398:1700-12.

[15] Psychiatry TL. Digital psychiatry: moving past potential. Lancet Psychiatry. 2021; 8:259.

[16] Deslich SA, Thistlethwaite T, Coustasse A. Telepsychiatry in correctional facilities: using technology to improve access and decrease costs of mental health care in underserved populations. Perm J. 2013; 17:80-6.

[17] Abazari S, Moulaei K, George M. Examining Outcomes and Challenges of Telepsychiatry in Australian Elderly: A Scoping Review. J Aging Res. 2023; 2023:8864591.

[18] Linardon J, Cuijpers P, Carlbring P, Messer M, Fuller-Tyszkiewicz M. The efficacy of app-supported smartphone interventions for mental health problems: a meta-analysis of randomized controlled trials. World Psychiatry. 2019; 18:325-36.

[19] Rony MKK, Das DC, Khatun MT, Ferdousi S, Akter MR, Khatun MA, et al. Artificial intelligence in psychiatry: A systematic review and meta-analysis of diagnostic and therapeutic efficacy. Digit Health. 2025; 11:20552076251330528.

[20] Chakrabarti S. Digital psychiatry in low-and-middle-income countries: New developments and the way forward. World J Psychiatry. 2024; 14:350-61.

[21] Rabbani F, Nafis J, Akhtar S, Siddiqui A, Merali Z. Home-based digital counselling by frontline community workers for anxiety and depression symptoms in rural Sindh, Pakistan: the mPareshan intervention. BMC Public Health. 2025; 25:2712.

[22] Sarwar MA, Sarwar H, Wardah S, Rana MS, Ashraf R. Perception towards telepsychiatry: A cross-sectional survey of psychiatry doctors in Lahore. Front Public Health. 2024; 13:2889-95.

[23] Glover JA, Williams E, Hazlett LJ, Campbell N. Connecting to the future: telepsychiatry in postgraduate medical education. Telemed J E Health. 2013; 19:474-9.

[24] Alghamdi SA, Alshahrani OM, Alharbi AK, Alghamdi OA, Almohaini RA, Alsayat JY. Telepsychiatry: knowledge, effectiveness, and willingness; assessments of psychiatrists in Saudi Arabia. Neurosciences (Riyadh). 2022; 27:79-86.

[25] Wojtuszek M, Kachnic J, Wutke J, Krysta K. Telepsychiatry in the opinion of Polish patients and psychiatrists. Eur Psychiatry. 2016; 33:S609.

[26] Orsolini L, Bellagamba S, Marchetti V, Menculini G, Valenta ST, Salvi V, et al. A Preliminary Italian Cross-Sectional Study on the Level of Digital Psychiatry Training, Knowledge, Beliefs and Experiences among Medical Students, Psychiatry Trainees and Professionals. Healthcare (Basel). 2022; 10:390.

[27] Das N. Telepsychiatry during COVID-19 - A brief survey on attitudes of psychiatrists in India. Asian J Psychiatr. 2020; 53:102387.

[28] Kamel MM, Westenberg JN, Choi F, Tabi K, Badawy A, Ramy H, et al. Electronic mental health as an option for Egyptian psychiatry: Cross-sectional study. JMIR Ment Health. 2020; 7:e19591.

[29] Feijt M, de Kort Y, Westerink J, Bierbooms J, Bongers I, IJsselsteijn W. Integrating technology in mental healthcare practice: A repeated cross-sectional survey study on professionals’ adoption of Digital Mental Health before and during COVID-19. Front Psychiatry. 2023; 13:1040023.

[30] Ahmed Z, Bhinder KK, Tariq A, Tahir MJ, Mehmood Q, Tabassum MS, et al. Knowledge, attitude, and practice of artificial intelligence among doctors and medical students in Pakistan: A cross-sectional online survey. Ann Med Surg (Lond). 2022; 76:103493.

[31] Al-Ansari AM, Malalla MK. Psychiatrists’ attitudes toward artificial intelligence: tasks, job security and benefits. Bahrain Med Bull. 2023; 45:1528-31.

[32] Asad N, Pirani S, Osama K, Nadeem T. Patients’ experiences with tele-mental health services during COVID-19 in Pakistan. East Mediterr Health J. 2024; 30:283-91.

[33] Ali SH, Bhatti AG. Indigenous healing practices of mental illness in Southern Punjab. IUB J Soc Sci. 2022; 4:75-87.

[34] Doraiswamy PM, Blease C, Bodner K. Artificial intelligence and the future of psychiatry: Insights from a global physician survey. Artif Intell Med. 2020; 102:101753.

[35] Guo J, Li B. The Application of Medical Artificial Intelligence Technology in Rural Areas of Developing Countries. Health Equity. 2018; 2:174-81.

[36] Ibrahim H, Liu X, Zariffa N, Morris AD, Denniston AK. Health data poverty: an assailable barrier to equitable digital health care. Lancet Digit Health. 2021; 3:e260-5.

[37] Naseem R, Wahab T. Exploring the future prospects of the healthcare sector of Pakistan considering the implementation of artificial intelligence in operations: extent of challenges and opportunities. Educ Manage Rev. 2023; 2:51-62.

[38] Chen M, Zhang B, Cai Z, Seery S, Gonzalez MJ, Ali NM, et al. Acceptance of clinical artificial intelligence among physicians and medical students: A systematic review with cross-sectional survey. Front Med (Lausanne). 2022; 9:990604.

[39] Alami H, Rivard L, Lehoux P, Hoffman SJ, Cadeddu SBM, Savoldelli M, et al. Artificial intelligence in health care: laying the Foundation for Responsible, sustainable, and inclusive innovation in low- and middle-income countries. Global Health. 2020; 16:52.

[40] Mendes-Santos C, Weiderpass E, Santana R, Andersson G. Portuguese Psychologists’ Attitudes Toward Internet Interventions: Exploratory Cross-Sectional Study. JMIR Ment Health. 2020; 7:e16817.

[41] Sarradon-Eck A, Bouchez T, Auroy L, Schuers M, Darmon D. Attitudes of General Practitioners Toward Prescription of Mobile Health Apps: Qualitative Study. JMIR Mhealth Uhealth. 2021; 9:e21795.

[42] Mayer G, Gronewold N, Alvarez S, Bruns B, Hilbel T, Schultz J. Acceptance and Expectations of Medical Experts, Students, and Patients Toward Electronic Mental Health Apps: Cross-Sectional Quantitative and Qualitative Survey Study. JMIR Ment Health. 2019; 6:e14018.

[43] Nogueira-Leite D, Diniz JM, Cruz-Correia R. Mental Health Professionals’ Attitudes Toward Digital Mental Health Apps and Implications for Adoption in Portugal: Mixed Methods Study. JMIR Hum Factors. 2023; 10:e45949.

[44] Alzahrani S. Assessing the Readiness of Using Virtual Reality in Mental Health Practice in Australia. In: Proceedings of ACIS 2021; 2021. pp. 84.

[45] Vincent C, Eberts M, Naik T, Gulick V, O’Hayer CV. Provider experiences of virtual reality in clinical treatment. PLoS One. 2021; 16:e0259364.

[46] Rimer E, Husby LV, Solem S. Virtual Reality Exposure Therapy for Fear of Heights: Clinicians’ Attitudes Become More Positive After Trying VRET. Front Psychol. 2021; 12:671871.

[47] Kazi AM, Qazi SA, Ahsan N, Khawaja S, Sameen F, Saqib M, et al. Current Challenges of Digital Health Interventions in Pakistan: Mixed Methods Analysis. J Med Internet Res. 2020; 22:e21691.